It's the ACA-nniversary
And this year feels a little different.
I kept thinking about the Affordable Care Act this week — partly because it was impossible to miss, with constant reminders of today’s 14th anniversary.
Columbia University released oral interviews with key ACA architects, including staffers like Nancy-Ann DeParle and Liz Fowler, as part of their Obama presidency project. The Biden administration blasted out messages touting record ACA enrollment and their efforts to defend the 2010 law, with more videos and emails to come this weekend.
I was also on Capitol Hill the past couple days, where Democratic lawmakers and staff were eager to jab at Republican critics of Obamacare — and frustrated that other news kept overshadowing their message.1
One reason Democrats are so keen to talk up the Affordable Care Act: Donald Trump gave them an opening. The former president and current GOP candidate is again pledging to repeal the law, even though more Americans than ever depend on it for health coverage, as we wrote recently in The Washington Post:
Obamacare enrollment hits record level as Trump vows repeal
Every year since the ACA passed, there’s been some effort to mark the anniversary. But something about this year feels different… more political messaging, perhaps. Certainly more emails about it in my inbox.
Part of that, I think, is the presidential election injecting real stakes into the ACA fight.2
But it’s also because the ACA story has changed. It was a political weight on the Democratic party for the first seven years or so of its existence. Republicans’ pledges to repeal Obamacare helped them win back the House in 2010, the Senate in 2014 and the White House in 2016.
Then came a turning point — a moment when it became clear that the law had staying power and popular support.
Sen. John McCain’s thumbs down to block repeal in July 2017 is burned into history, but I’d point to this earlier moment in March 2017, when House Republicans tried and tried and tried to repeal the law, but were left thoroughly embarrassed.3
Seven years later, the ACA is widely seen as a policy success and a political boon. It’s clearly imperfect, but it’s also the source of health coverage for tens of millions of Americans. Its provisions have transformed key parts of the U.S. health system.
When I talk to lawmakers and officials who were closely involved with the ACA battle, they frequently describe it as a career highlight — maybe the most important thing they’ve ever done.
Personal reflections
The health reform fight was also transformative for my own, smaller career. I wasn’t a reporter back then — just a guy working for a health care research and consulting company. I wasn’t particularly interested in politics; I knew virtually nothing about Congress.
Then a series of unexpected events turned me into the company’s ACA news analyst — a job I really didn’t want at first.4
Tracking and analyzing the ACA came to consume my life. After President Obama signed the bill into law, 14 years ago today, I remember going to the swimming pool at the hotel next to our office and just floating in the water, not sure what I was supposed to do next.
(So it’s hard not to be reflective! It’s more than a little strange to go from being the guy reading The Washington Post’s Obamacare coverage 14 years ago to being the guy writing that coverage now!)
Thinking about the ACA fight, I messaged a bunch of the people who actually lived it, some of whom shared stories with me about what it was like inside those rooms.
I also went back and looked at my own tweets from March 2010. I had forgotten that the White House immediately put out this collection of behind-the-scenes photos, showing Obama and other officials strategizing, cajoling, even blowing off steam by shooting hoops as they battled to get the Affordable Care Act passed.
One of those photos is the header of this piece, a shot of Obama trying to close the deal before the final votes in Congress. Below is another from the collection — Obama trading messages on his BlackBerry, basking in the biggest political win of his presidency.
I’d bet Sen. Chris Murphy would like to have this tweet back.
Another factor is that the Biden administration actually wants to celebrate the Affordable Care Act, unlike the Trump administration that mostly just slagged on the law for four years.
Yes, House Republicans eventually passed an Obamacare repeal bill six weeks later, but their earlier collapse shattered the image that repeal was inevitable.
Leading up to Obama’s inauguration in 2009, I’d had the idea to prepare a special brief on all the key officials who would oversee his health care efforts, a move that caught the attention of senior executives at my company. They soon told me that they’d created a new job: to lead news coverage of Obama’s health care reform agenda.
I initially fought the assignment — I remember telling one senior executive that I thought Obama’s health care push would burn out, just like previous presidents’ efforts; I’m glad that executive ignored me and reassigned me anyway.
It ended up becoming a major professional opportunity, landing me in regular meetings with the company’s top leaders, who patiently listened to my analysis and updates. I mostly remember trying not to be intimidated, not to say anything stupid and not to be the junior staffer who got kicked out of the room.
What I’m amazed about is that the people who passed ACA thought that healthcare insurance exchanges would be The Thing but despite the Supreme Court’s kneecapping universal Medicaid expansion, in fact it’s been Medicaid expansion that has been transformative! It’s been passed again and again in ballot initiatives, and that despite decades of negative messaging about it! I’m thrilled to be honest, both because Medicaid is truly accessible, with very low if any copays and no monthly premium burden.
I personally have both Medicaid and Medicare, and to me that is the perfect combination, insofar as Medicaid covers glasses and dental, and Medicare for all has been a progressive rallying call. I think both should be a thing for everyone to have, rather than one or the other.
When the Supreme Court is expanded, I would definitely like for the ACA to reach it again and Medicaid universal expansion to be a Thing and finally equitable care would take place. Increasing the income able to be covered should also be explored, because 138% of the poverty income level can still not be a living wage.
It’s a travesty that original Medicaid is allowed to be capped at 17% of the poverty income level in Texas, a thing that exists literally nowhere else. No wonder so much of Texas are healthcare deserts in and of themselves, despite the clear need and the fact that maternal care deserts are the inevitable byproduct of that. Pro life amirite.